Living through the physical and emotional toll of breast cancer is so traumatic that some women can’t bear the thought of doing it again. That’s why a growing number of women who have already been diagnosed with cancer in one breast are taking the drastic measure of having both breasts removed (a procedure called prophylactic mastectomy). Yet a University of Michigan study presented last week at the American Society of Clinical Oncology’s Quality Care Symposium showed that nearly three-quarters of women who had this procedure were actually at very low risk of developing cancer in the healthy breast. In other words, many women are unnecessarily exposing themselves to the potential risks of a double mastectomy—including pain, infection, and scarring. The new study suggests that more and better information about breast cancer recurrence—and the risks and benefits of prophylactic mastectomy—are needed as women consider this procedure.
October is Breast Cancer Awareness Month. Sponsored by national public service organizations, professional medical associations, and government agencies, it aims to make sure women all across America have the information they need to identify breast cancer early and take all of the steps needed to fight it. This year, Harvard Health Publications, where I am the Chief Editor of Books, offers a unique contribution to Breast Cancer Awareness Month: our newest book, Hope and Healing for Your Breast Cancer Journey. This book, part of the Chicken Soup for the Soul Health series, weaves the stories of more than 25 women diagnosed with breast cancer and their family members with practical information about managing a support team, getting through treatment, healing body and soul, and more. In this post, I share a moving story from the book, “I Miss My Breasts,” written by Linda A. Fiorenzano, a project and risk management professional who was diagnosed with breast cancer at age 36.
Researchers at Kansas State University have developed a blood test that rapidly detects breast cancer (as well as non-small cell lung cancer) in very early stages, long before symptoms appear or the cancer can be seen by other methods. The experimental test identifies enzyme patterns that differ from one type of cancer to another. According to the researchers, the test can detect very early breast cancers (stages 0 and 1), as well as early lung cancers (stages 1 and 2), within an hour, with 95% accuracy. However, they tested only 32 participants with various stages of breast or lung cancer, as well as 12 people without cancer. Whether finding cancer that early makes a difference for treatment and survival remains to be seen.
For years researchers have been trying to weigh the benefits of finding early breast cancers against the risks related to false positives (the spots that turn out to be harmless). This work has sparked some bitter public debates and confusion for women over flip-flopping recommendations. The latest salvo comes from a review of the results of mammograms among more than 12 million women in 18 European countries. The results support the idea that routine mammograms can prevent deaths from breast cancer without causing undue harm. The findings support the U.S. Preventive Services Task Force’s recommendation that women between the ages of 50 and 74 have a mammogram every other year. Women at higher risk of developing breast cancer may need mammograms earlier than age 50, or more often than every other year.
Daily exercise appears to reduce a woman’s risk of developing breast cancer, according to a study published online in the journal Cancer. The type or intensity of the exercise didn’t seem to matter, as long as it was done often. How much exercise is needed to lower breast cancer risk? In this study of 3,000 women, 10 to 19 hours a week (about two hours a day) had the greatest benefit. Age didn’t seem to matter—physical activity reduced breast cancer risk in younger women during their reproductive years and older women after menopause. What did make a difference in the effect of exercise was weight gain—especially after menopause. Gaining a significant amount of weight essentially wiped out the benefits of exercise on breast cancer risk in older women.
Results of a study presented at the annual meeting of the American Society of Clinical Oncology in Chicago indicates that an experimental drug combination could be effective against HER-2-positive breast cancer. The new therapy, called trastuzumab emtansine (T-DM1), combines a monoclonal antibody with a potent chemotherapy agent. The combination is exciting because Herceptin guides the cell-killing chemotherapy agent to HER-2 receptors on breast cancer cells. This focused attack targets cancer cells and largely bypasses healthy cells, which the chemotherapy drug would otherwise damage. In the study, which included nearly 1,000 women with HER-2-positive breast cancer that had spread either within the breast or elsewhere in the body, 65.4% of the women taking T-DM1 were still alive after two year, compared to 47.5% of those on standard treatment for this type of cancer. In addition, women on T-DM1 experienced far fewer side effects.
Breast cancer isn’t just a woman’s disease. Men can get it, too—about 1% of breast cancer is diagnosed in men. Since few men know that, they often fail to recognize its earliest signs and end up seeing a doctor later in the process than women do. The result: Men face treatment for larger and more advanced tumors, and their cancer is more likely to have spread to other parts of the body. The largest study to date on outcomes in men with breast cancer indicates that the five-year survival rate for women with breast cancer was 83%, compared to 74% for men. Even men diagnosed with early stage breast cancer still fared worse than women, although the gap closed for men and women diagnosed with later-stage disease. Since breast cancer in men isn’t often on doctors’ radar screens, men should be aware and check themselves.
The FDA today revoked its 2008 approval of the drug Avastin to treat breast cancer, concluding that the drug does little to help women with breast cancer while putting them at risk for potentially life-threatening side effects. Avastin will remain on the market (and so be potentially available to women with breast cancer) because it has also been approved to treat other types of cancer.
A 28-year study of 106,000 women found that moderate alcohol slightly increases a woman’s risk of developing breast cancer. Women who had the equivalent of three to six drinks a week had a modest increase in their risk of breast cancer (15%) compared to women who never drank alcohol. That would translate into an extra 3 cases of breast cancer per 1,000 women per year. The risks were the same for wine, beer, and spirits. Because moderate drinking appears to prevent some types of heart disease—which affects more women than breast cancer does—it’s important for women to think about alcohol in light of their own personal health situation.
New government statistics show that there are nearly 12 million cancer survivors in the United States. In many ways this is terrific news, and a testament to improved diagnosis and treatment options. But there’s a flip side to surviving cancer, and many survivors are never totally “free” of the disease. The ongoing psychological and emotional issues can be almost as much a challenge as cancer treatment was. Harvard Health editor Ann MacDonald explores the ongoing fear of recurrence, survivor guilt, the “Damocles syndrome,” and more.